title: Timing of temporary right ventricular assist device insertion for severe right heart failure after left ventricular assist device implantation.
abstract: Data on how the timing of a temporary right ventricular assist device (RVAD) insertion affects outcome are limited in patients receiving left ventricular assist device (LVAD). Of the 282 patients who underwent LVAD placement between January 2000 and November 2010, 40 (14%) required concomitant (n = 26) or delayed (n = 14) RVAD insertion as temporary support. We analyzed early and 1-year outcomes. Preoperative variables were similar in the concomitant and delayed RVAD groups. The hospital mortality rate was approximately 50% in both groups (p = 0.82). The 1-year actuarial survival was similar in both groups (p = 0.42). Patients who required RVAD support had higher in-hospital mortality and worse 1-year survival rates than those who received LVAD only (48% vs. 9.5%, p < 0.0001; 40% vs. 82%, p < 0.0001). Multivariate logistic regression analysis indicated RVAD use as a significant risk factor for 1-year mortality (odds ratio, 18; p = 0.0003; 95% confidence interval, 3.765-86.74). Timing of temporary RVAD insertion did not affect overall survival. Necessity of RVAD support is associated with significantly worse early and late mortality at any rate. The decision to place the RVAD can be made once it is clinically necessary.
authors.affiliation: From the *Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY; and †Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Yang
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
mesh_terms: D013504:Cardiovascular Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000601:surgery; D006352:Heart Ventricles / Q000601:surgery*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013995:Time; D018497:Ventricular Dysfunction, Right / Q000601:surgery*